Transgender Patients Could Be Denied Care Under Proposed Mississippi Law

UPDATE: Mississippi Governor Phil Bryant announced April 5, 2016, he had signed the "religious freedom" law.

A wide-ranging “religious freedom” bill, now headed for the Mississippi governor’s desk, would bar punishment for doctors who deny care to transgender patients going through a transition.

The bill runs counter to the explicit policy of the American Medical Association for treating members of the LGBT community. While its language clearly targets gender reassignment care, the only care it specifically says must be provided to transgender patients is “emergency medical treatment,” a term that is not defined in the bill.

Much of the proposed law, called the “Protecting Freedom of Conscience from Government Discrimination Act,” seeks to allow businesses to deny wedding-related services to same-sex couples, now that the US Supreme Court has told states that gay and lesbian couples can marry. Individual government employees, such as clerks, could decline to issue marriage licenses. Unlike a new law in North Carolina, this one lets individual businesses and schools make rules about restroom use.

However, if a business or state entity seeks policies of inclusion for LGBT persons, the law would protect employment for those who hold the view that “Marriage is or should be recognized as the union of one man and one woman.”

It’s the provision that would allow endocrinologists or other physicians to decline write prescriptions for hormones or provide other care to transgender patients undergoing transition that appears to break new ground. The bill bars any state sanction, including action against a medical license, for a person who, “wholly or partially” on the basis of religious belief refuses to provide treatment, counseling, surgery, or fertility services.

Advocacy groups warned, for example, that the bill could protect counselors for refusing to help a transgender teenager who calls a suicide hotline. The law includes specific protections for state employees to express their opinion on gender identify issues; it is unclear what affect this would have on places like the University of Mississippi Medical School, which provides emergency care and employs state workers.

A recent survey by Michael Irwig, MD, associate professor of medicine at George Washington School of Medicine in Washington, DC, found that 30% of endocrinologists were unwilling to see transgender patients, and nearly half felt unsure of their competency to treat them.

"The transgender community represents one of the most underserved and marginalized populations in health care," Irwig said when the results were released. "It is therefore up to the physician population to become more familiar with their needs and train the next generation to be culturally competent and prepared to treat this growing community."

Mississippi lawmakers included the provision to allow the denial of medical care, despite the AMA’s clear position on this issue. The first point in the AMA policy on treating members of the LGBT community states that it will oppose “any discrimination based on an individual’s sex, sexual orientation, gender identify, race, religion, disability, ethnic origin, national origin or age and any other such reprehensible policies.”

Mississippi Governor Phil Bryant, a Republican, said through a spokesman Thursday night he had not decided whether to sign the bill. The bill must first go back to the state House of Representatives for concurrence on an amendment, which is expected. If Bryant signs the bill, the law takes effect July 1, 2016.